Recently tested positive; probably unknowingly chronic since birth; need some advice for current relationship

Living With Hep B Relationships
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Hi all,

I discovered and joined this community recently as I was doing some research about this condition over concerns I have over how this might affect my current intimate relationship. I’ve found so much valuable information here and so much kindness and support, even in the prompt replies to my first ever comments, so first and foremost I’d like to thank everyone here again for sharing their experiences, expertise, and care :folded_hands:

I got a lot of reassurance from the information I could already find but I still have some open questions about my specific situation, which I hope someone here could help answer.

A brief overview of my situation:

  • Tested positive for HepB antigens and negative for antibodies, 1.5months ago during a standard health screening. Liver function tests all normal.
  • Took me by surprise as I’ve been vaccinated since birth in accordance with my country’s national immunization program; however, I’ve long known my mom is my carrier
  • My personal history strongly suggests I have been an asymptomatic chronic carrier since birth, although I will only go for follow-up tests 4.5 months later. (Though this is somehow the first time I got a HepB panel so I will never be 100% sure when I was infected–it was not included in my previous health screening, and I was never actively thinking about it despite my family history since I always assumed I had immunity)
  • I am relatively young and live a very healthy lifestyle (regular exercise, good diet, zero alcohol)
  • Currently in a long-distance intimate relationship. I was physically with my partner for a month before I went for the health screening and tested positive for HPB, and we had a lot of unprotected sex
  • Immediately updated my partner about my results after I got them and told him to get tested. His results came back negative for both antigens and antibodies couple of days ago. A relief! I told him to get vaccinated ASAP, and he’s scheduled for his first shot today.
  • Buuuut the full series is only complete after 6months, and he will be visiting and we will be physically together again in ~2months time, meaning he will only have managed the second shot by then

This is where I have some open questions that I’m hoping this community can help answer. I’ve asked him to check with his doctor today too but it would be very good to also get some independent validation. Obviously, I want to continue being sexually intimate with him and would love to avoid protection if it’s possible, again for obvious reasons, so:

  • Would you recommend him to get tested for his immunity (which I assume is to just run the standard HepB panel which includes the test for antibodies, please correct me if I’m wrong) before he visits so that we can be sure he has responded properly to the vaccine?
  • Also, is there a standard level of immunity above which we can say the risk of transmission is really negligible? Like a certain cut-off point for levels of HepB antibodies? And would this generally be reached by the second booster or is just testing for antibodies the best way to find out?
  • Would you recommend that I do a HepB viral load test as well before he comes just to be sure my load is low? From what I understand talking to my mom, they don’t recommend viral load tests here until you are actively managing a flare-up, as it’s quite expensive (>$200). I’m not technically due for my follow-up check up until 4.5months later, but even then I don’t think the doctor said to do a viral load test, just liver scan, liver function tests and the standard HepB panel again. So given that I didn’t infect my partner after all the unprotected sex we already had, and let’s say he manages to confirm his immunity after vaccination, do you think a viral load test is still a necessary precaution to take? It’s quite expensive so I’d like to balance utility with the cost, and I am trying to understand what the true utility really is here if we are taking all other sensible precautions already.

Those are my open questions, and then below is a summary of conclusions I got reading the information in this community, that I shared with my partner. Do you think these are reasonable and if there’s anything else I should be communicating with him? (And maybe having a nice summary here might also help others wondering similar things to me)

  1. Not so good news: even though it won’t be “fully confirmed” until I go for the screening again 6 months later, based on all info I think it’s highly highly likely I’m an asymptomatic carrier with a chronic infection, both based on my family and sexual history, and the fact that most chronic infections happens when one gets infected as a kid, not adult
  2. Good news: 90% of adults, whether vaccinated or not, who are exposed to HepB will be able to clear the virus without the infection becoming chronic. (Even though the symptoms of an acute infection won’t be fun. But just exposure also doesn’t mean you’ll get an acute infection with symptoms.)
  3. Good news: female-to-male/bottom-to-top transmission risk is “quite low” (I guess it makes sense) → question to the community: how low is “quite low”, exactly?:thinking:
  4. Good news: vaccination is very effective at preventing infection in the vast majority of cases (90-95%), but there is still a small percentage people who don’t develop antibodies and immunity even after vaccination
  5. Good news: infection usually happens when an infected person’s body fluids with the virus directly enters another person’s blood, like through a scratch of an open wound. So unless you have cuts/sores around your genitals, chances seem quite low. But definitely best to avoid sex when I’m actively bleeding :confused:
  6. Speculative good news: given that you weren’t infected after we had quite a bit of unprotected sex and I’m asymptomatic, and I also generally live healthily, I’m hopeful that my viral load is quite low, too low to even have much risk of transmission whether you’re vaccinated or not, but especially, if you’re vaccinated

It would also be good to know if anyone has any other advice for precautions we could take in our situation! Of course the ultimate fallback is to just use condoms…but would like to avoid that if possible :innocent: especially since we are still going to be going long stretches not physically together for awhile until we manage to settle in the same place :sob:

Thanks again for the help! :folded_hands:

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Also, I just realized I had a follow-up question. This is not so much relationship-related but really just about monitoring liver health. Even though my liver function tests all came back normal, it seemed like my ALT levels were on the high-end of normal (35 U/L against a reference range of <36 U/L). My AST was 26 U/L against a < 36 U/L reference range. This made me slightly worried if there’s already been some impact to my liver…so I was just wondering how accurate an indicator ALT levels are for actual liver damage? I also vaguely read somewhere that ALT levels also tend to increase after exercise due to muscle damage, and I’m a very regular exerciser, mostly yoga and strength training but also cardio from time to time, including frequently cycling to commute. Are these ALT and AST levels anything to worry about or am I overthinking it?

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In my opinion, these are all good questions and concerns that should be discussed with your heptalogist. Did you get tested for co-infections like hepA,C,D? HIV? Since you mentioned you are in a long distance relationship perhaps it’s a good idea.

Giving time for full dose of vaccination to take full effect and body to develop a strong antibody resistance should be considered.
Your partner should be tested annually or sooner if desired. Triple panel should suffice. DNA viral load and HepBeAG test would show if there is active replication in your partner in addition to the antibody.

While your body fights the virus you can have both hepb surface antigen and antibody.

ALT blood enzyme mostly from the liver so good indicator for health of your liver. AST marker to check liver in addition your kidney heart, and other organ health.

Again. Discuss with your doctor your valid concerns.

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Hi @axotylll,

Some people may develop antibodies after 2 shots given 1 month apart. It could give you peace of mind if he gets his antibodies checked a couple weeks after the second shot. Generally, the standard for immunity to hep B is 10 mIU/mL. Regardless of what that result says, it’s still important to complete the series so that the protection is long-lasting. The official standard of care is for sexual partners and household members of someone living with hep B to have their antibodies checked approximately 3 months after finishing the whole series.

Another caveat that I will tell you (and I hope this is not the case for you) is that hep B has a relatively long incubation period (around 3 months). Depending on how long ago you were last intimate with your partner, it’s possible that he could still be in the incubation period with a new infection, where it hasn’t shown up on blood tests yet.

I would recommend a viral load test if you can afford it, but I don’t think the result of that should really change the precautions that you take in the time until he’s fully vaccinated with confirmed immunity. Regarding your liver tests, it is true that ALT can increase due to muscle breakdown. I would avoid getting your blood drawn on a day when you feel sore post-exercise. A viral load test may be able to shed more light on whether the liver enzymes are elevated due to your hep B, or due to something else. 35 is not all that high, but I would say that it’s non-optimal.

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Thank you so much @TomPsu @et5656 @Bansah1 for the info and advice :folded_hands: Unfortunately I do not have a hepatologist at the moment. The GP who did the consult for my health screening results just said to do a follow-up liver panel, HepB panel and liver scan 6-months later and gave me a referral letter. So by that point (end of this year), I suppose I will have a proper doctor I can actually ask these questions to, unless I do the follow-up earlier (but should I?) The GP never mentioned about testing for any other hepatitis types or HIV, or much more else, really :frowning: (I still feel a little angry about how little info I was given, idk what the consult fee was for).

I feel like I live in a very low-risk country and live a low-risk lifestyle for all these other potential diseases, but maybe I am being complacent just like I was about HepB, I don’t know. I don’t believe my mom ever tested for any of these, for example, never heard her talk about it or mentioning her specialist saying it was necessary. After typing this, I checked online and saw that it’s also recommended by our government. Then I asked mom whether she ever tested for these things before and she said, “no”…then, “I don’t know, maybe I did, but I don’t remember.” Well, maybe this is something that they would ask me to do during my first meeting with the specialist 6 months later? But technically speaking, is there any reason to wait? Should I just go and do it before my boyfriend comes to get some peace of mind and actually have a proper doctor to ask about these things?

Re: boyfriend’s vaccination, it’s weird since he said his schedule is 0-7-21days then 6 months…so 4 shots total? So he would actually manage to get the third shot before he flies over. But he said the doctor told him there’s no point testing for antibodies until 1-3 months after the full series is over. So at first I thought, well then I guess we can forget about that and we’ll just make sure we only have protected sex. But then reading @et5656 's caveat, I am worried again since, unfortunately, although it feels like a very long time since we were last together, it’s not actually been 3 months yet, only slightly more than two months by the time he got his results. So now I wonder if he should just go and do another test anyway before he comes, if not for the antibodies then at least just to confirm again that he’s negative for the antigens. I will ask him to check with the doctor again when he goes for his second shot. But either way, safety first and we’ll stick with condoms for sure.

And this

The official standard of care is for sexual partners and household members of someone living with hep B to have their antibodies checked approximately 3 months after finishing the whole series.

(deleted my original paragraph as I realized I was ranting against a misreading of the above (somehow interpreted it as check approx. “every 3 months”!!) :joy: reading again it makes much more sense, I think this is basically what the doctor told my boyfriend then. My frustration and anxiety about this whole thing is messing with my brain for sure.)

Anyway, thanks again for the helpful and caring advice! In sum, I will consider going for my specialist appointment earlier (before my boyfriend arrives), ask my boyfriend to check with his doctor again on whether it’s worth getting another HepB panel after the third shot, and we will stick to condoms :victory_hand: .

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Hi @axotylll,

Thank you for sharing your story and sorry it has been so stressful, even with the very happy event of reuniting with a loved one. Your plan sounds like a good one.

As referred above, the vaccination protects pretty quickly after the shot (this is why birth dose vaccination can protect babies straight away), but requires the full course to ensure long-term protection. This hopefully puts you at ease a bit.

Regarding your other questions:

It’s very hard to do these studies, and it is mostly to contrast it to the higher risk of male-to-female/top-to-bottom transmission.

Yes correct, but transmission can also occur through microabrasions that occur in genital tissues during penetrative intercourse and other sexual activities.

Hope this helps a bit.

Cheers,

Thomas

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Thanks so much @ThomasTu for addressing some of my questions.

Just as an update, today I finally managed to go for an appointment with a hepatologist at the hospital. I went to see a GP at a government clinic the week before to get a referral so I could get subsidized rates at the hospital. I was not very impressed with the GPs (both at the government clinic and the private clinic where I did my health screening) both in terms of knowledge and bedside manners/empathy, but thankfully this hepatologist helped to restore my faith in medical professionals :joy: she managed to address all my concerns, was empathetic and made me feel very comfortable. What a difference good bedside manners makes!

In the end I can’t be diagnosed as “chronic” until I do a follow-up HepB test 6 months after the initial one (even though I’m 99% sure I’m chronic), so that will have to wait till early next year. But I decided to go ahead and do the eAntigen/eAntibody test and viral load test first, just to have more peace of mind before my partner comes. (I also threw in Hep C and HIV, why not; even though risk seems very low but good to just have a baseline. Apparently my health screening results also showed that I am HepA immune, which I didn’t even realize at first; I guess that small line with strange acronyms was completely overshadowed by the positive HepB antigen one)

My hepatologist also addressed the concern of the possibility of my partner still being in the incubation period of an infection even with a negative antigen test result after 2 months since last sexual contact – she assured me it would be quite improbable that my partner is infected since he didn’t get any symptoms, and adults usually get symptoms from an acute infection when their immune systems respond. Whereas a infected baby’s immune system doesn’t even realize there’s an intruder in the system and hence chronic carriers tend to be asymptomatic (at least this is what I understood). And yes, sucks to be me but most likely mom probably just had high viral load when she had me compared to my siblings and I just already got infected at birth so subsequent vaccination didn’t help anyway.

However, both the GP and hepatologist seemed surprised to hear about my partner’s 4-course vaccination series. He said he was given two options, a 3 shot one that would be completed in 6 months but for which immunity would develop a little slower, or a 4 shot one that would be completed in 12 months but with the first 3 shots only a week apart, so presumably there will be a higher chance to develop immunity sooner. Not sure if anyone here has heard of this. Maybe it’s a European thing :person_shrugging: Anyway, I think I’ll just ask him to get antibodies tested after the third shot just to be on the safe side, and hopefully both our test results will come back okay.

Thanks again for all the help and support here :smiley: :folded_hands:

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Great plan and attitude, @axotylll! So glad you found a doctor who works for you and please keep us updated on how it goes!

Cheers,
Thomas

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